AB0525 MODELS OF SYSTEMIC LUPUS ERYTHEMATOSUS ACTIVITY (A RESTROSPECTIVE-PROSPECTIVE STUDY)
Authors: A. Shumilova, E. Travkina, M. Cherkasova, T. Reshetnyak, A. Lila
Journal: Annals of the Rheumatic Diseases (2022)

Background Systemic lupus erythematosus (SLE) is a heterogeneous chronic autoimmune rheumatic disease with a wide range of clinical manifestations, characterized by impaired activation of cellular and humoral links of immunity, uncontrolled hyperproduction of autoantibodies of a wide spectrum to nuclear antigens and the formation of immune complexes that cause immuno-inflammatory damage to tissues and organs. This disease is characterized by periods of exacerbation and remission, over time, the activity of SLE may change, mainly in response to therapy. Despite this, patients can be classified according to the current or currently prevailing activity model. Objectives To study the activity patterns of patients with SLE. Methods The retrospective-prospective study was conducted from 2019 to 2021 based on the study of the history of the disease and annual visits of patients with an assessment of the activity of SLE by SLE Disease Activity Index-2000 (SLEDAI-2K). Depending on the level of SLEDAI-2k flare index, the models of SLE activity, the number of exacerbations during the observation period and the period of the disease, as well as the predominance of organs and systems involved in the process were analyzed. The study included 183 patients with SLE (163 women and 20 men). The average age was 37.5±12.8 y.o. The duration of the disease was Me=9.9 [2.0; 16.0] years. Results The clinical and immunological manifestations of SLE were evaluated in the study. The average number of exacerbations of SLE during the period of the disease was 2.9±1.9. The average number of exacerbations during the observation period was 1.1±0.78. The most frequent exacerbation was manifested by a lesion of the musculoskeletal system – 29,5% (54 patients), the skin-mucous system – 21,8% (40 patients) and lupus-nephritis – 21,8% (40 patients). The predominant activity model was relapsing-remitting disease (RRD) – 43,16% (79 patients), then chronic active disease (CAD) - 38,15% (70 patients), and minimal disease activity (MDA) – 7,1% (12 patients). Clinical quiescent disease (CQD) had 21 patients (11,47%). Models of SLE activity and involvement of systems and organs are presented in Table 1. Table 1. Models of SLE activity and involvement of systems and organs in patients with SLE. 23 patients with involvement of the skin-mucosal system had 1 exacerbation of SLE in 3 years of the study. 23 patients with involvement of the musculoskeletal system had 1 exacerbation and 19 patients had 2 exacerbation of the disease in observation period. Exacerbation of lupus nephritis 1 time during the follow-up period was noted in 26 patients, 2 times - in 8 patients. Conclusion The most frequent model of SLE activity is RRD, which characterizes periods of exacerbation and remission. The most frequent clinical manifestations of exacerbation of SLE are lesions of the skin-mucous and musculoskeletal systems, as well as lupus nephritis. References The study was performed at the V.A.Nasonova Research Institute of Rheumatology within the framework of the fundamental topic FURS-2022-003. [1]Zen M, Bassi N, et. al. Disease activity patterns in a monocentric cohort of SLE patients: a seven-year follow-up study. Clin Exp Rheumatol. 2012 Nov-Dec;30(6):856-63. Epub 2012 Dec 17. PMID: 22765883. [2]Doria A, Gatto M, Zen M, Iaccarino L, Punzi L. Optimizing outcome in SLE: treating-to-target and definition of treatment goals. Autoimmun Rev. 2014 Jul;13(7):770-7. doi: 10.1016/j.autrev.2014.01.055. Epub 2014 Jan 27. PMID: 24480071. [3]Steiman AJ, Gladman DD, Ibañez D, Urowitz MB. Prolonged serologically active clinically quiescent systemic lupus erythematosus: frequency and outcome. J Rheumatol. 2010 Sep;37(9):1822-7. doi: 10.3899/jrheum.100007. Epub 2010 Jul 1. PMID: 20595281. Disclosure of Interests None declared